Vancouver police mental health team tries to stop the revolving door of arrest and treatment

Gerry Bellett, Vancouver Sun04.25.2013

Sgt. Howard Tran, who is in charge of Vancouver Police’s mental health team in Vancouver, BC, April 23, 2013. Officers are part of the Assertive Community Treatment team that takes mental health and addiction treatment to persons living in the community who are hard to treat.Arlen Redekop
/ Vancouver Sun

Sgt. Howard Tran is in charge of Vancouver Police’s mental health team, a group dedicated to reaching out to those who have been arrested for various offences and are not capable of being treated through traditional outpatient care.Arlen Redekop
/ Vancouver Sun

Sgt. Howard Tran, who is in charge of Vancouver Police’s mental health team in Vancouver, BC, April 23, 2013. Officers are part of the Assertive Community Treatment team that takes mental health and addiction treatment to persons living in the community who are hard to treat.Arlen Redekop
/ Vancouver Sun

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Christopher Lui began hearing voices five years ago — a terrifying and bewildering interruption in the life of a hard-working student trying to earn a mechanical engineering degree from BCIT.

At the time he was 24 years old with no history of mental illness.

And it came upon him suddenly, no different from the way other chronic illnesses strike.

“I had no idea I was ill. I just started hearing voices but it wasn’t people talking to me, they were hallucinations,” said Lui. “And it was very frightening.”

He was diagnosed as suffering from schizophrenia, most likely brought on by stress.

“I was feeling a lot of stress at school at the time and the doctors felt this was the cause,” he said.

Since that first episode there have been flare-ups and three years ago he was hospitalized for almost three weeks in Vancouver General Hospital after one particularly severe attack.

Again it appeared to be related to stress at college and so he took a semester off to decompress.

“It really helped. I returned to school in 2012 and this is my last term,” Lui said as he got ready for his final exams at the end of this month.

While he hasn’t suffered a major relapse in three years, his mental health has fluctuated.

At the beginning of April he suffered another flare-up.

But this time, instead of being hospitalized, he was treated by the Acute Home Based Treatment team, one of the VGH and UBC hospital’s mental health outreach teams that are taking services into homes and homeless shelters and to people living on the street.

“We’ve treated people living in a $4 million penthouse in Shaughnessy and someone living in a car,” said Dr. Hiram Mok, a psychiatrist and the medical manager of the AHBT team.

The team, which became operational in 2009, consists of 15 clinicians with varying professional backgrounds — psychiatrists, occupational therapists, nurses, social workers.

Services are available from 9 a.m. to 9 p.m. every day of the year and their average daily caseload is 26 patients.

The team is there to smooth the transition of patients being discharged into the community from in-hospital psychiatric care for psychosis or illnesses such as bi-polar disorder.

“We stay with them for about three weeks and will visit them three times a day in their homes, if necessary,” said Mok.

“We are there to assess and monitor the effects of medication and its side effects. We are seeing the client in their own environment so we can see what their family is like and their support system and can help our client understand their illness and help them remember to take their medication,” said Mok.

“We can help them with any concerns and any stresses or problems that need solving. We are there to help them connect with their jobs and with the community mental health teams that will be providing their long-term care,” he said.

“We want to make sure that when people leave hospital they don’t fall through the cracks. The period between discharge and their coming into the care of a community mental health team is critical because during that time people can crash and have to be readmitted to hospital,” he said.

(There are a number of community mental health teams located throughout the city that care for patients with chronic and persistent mental illness.)

It was government health care cuts and a 15-per-cent reduction of in-patient beds for psychiatric patients that forced the adoption of a mobile, community-based mental health and addiction services outreach program, Mok said.

“We had to create a new strategy to reduce the length of patient stay in hospital and expedite patient’s discharge. So we chose to follow a model of home-based treatment that has been successful in England and Australia,” he said.

According to Vancouver Coastal Health, by March 2012 the AHBT program had reduced emergency department visits of mentally ill patients by 48 per cent, reduced hospital admissions by 51 per cent and cut hospitalization days by 44 per cent.

For Lui, the AHBT team’s intervention in early April was a relief.

“I was experiencing extreme anxiety — trying to focus on the TV or radio or other people’s conversations. I wasn’t hearing voices but the team came out and tried to help me figure out the cause of the flare-up. I’ve had a change in medication and the symptoms have subsided almost 100 per cent,” he said.

Mok and the AHBT team are stationed in a small collection of offices at VGH on the ground floor, near their colleagues working for the Assertive Community Treatment (ACT) team.

While participation in receiving AHBT services is optional — patients being discharged can refuse to allow the team to visit them at home — the ACT team’s services aren’t.

The “assertive” part of the ACT team’s title makes that plain, as does the presence of Vancouver police officers embedded in the team, which deals with patients whose mental illness and addiction have resulted in their being arrested and charged with offences and who are not capable of being treated by traditional outpatient care.

“The ACT team are like minesweepers — they pick up anyone in the community who is in distress. They are dealing with situations that could be quite dangerous at times,” Mok said.

It’s Vancouver’s Downtown Eastside that attracts most of the ACT team’s attention.

Dr. Soma Ganesan, the head and medical director of Vancouver Coastal Health’s psychiatry department, outlines the scope of the problem.

“The Downtown Eastside has a population of around 18,000 and we’re probably serving about 8,000 or so of those people with mental health, addiction and primary care,” said Ganesan.

“A lot of them have complex problems. They have mental health issues, addiction issues and chronic medical conditions. Any number of those clients experience various persistent mental illnesses such as schizophrenia; a number have post-traumatic stress disorder, chronic depression, anxiety, personality disorders, bi-polar — conditions that we haven’t traditionally served well through our mental health teams.

“But we are changing our mandate to better serve that population,” said Ganesan.

Much of the impetus to do this came from the police.

Statistics show that 24 per cent of all calls for police intervention in Vancouver are the result of mental illness, with the police making over 3,000 mental health apprehensions in 2012 — many of them originating in the Downtown Eastside.

Sgt. Howard Tran is the officer in charge of the VPD’s newly formed mental health unit.

Tran says the unit owes its formation to two internal reports — the first produced in 2008, the followup in 2010 — that were critical of the lack of treatment and facilities for the mentally ill, as well as the lack of housing for them.

The reports conveyed the police’s frustration with taking persons needing treatment into custody only to have them released untreated a short time later.

They highlighted the constant drain on police resources by mentally ill and drug-addicted persons and estimated that the time spent dealing with this group consumed the efforts of 90 full-time officers and was costing $9 million a year in wages.

As an example of how the system was failing, they told of one person suffering from schizophrenia who was arrested weekly by police and who during 2007 had 112 documented contacts with police and had been taken to hospital nine times during the same period.

“We basically said the system needed more capacity to deal with these folks,” said Tran.

“There were not enough beds and not enough resources. We’d become de facto mental health workers and we weren’t comfortable with that. We felt the system was failing these folks — that was the most important thing — because they were being criminalized for being mentally ill,” said Tran.

The 2010 report recommended setting up an ACT team based on a program that was formed in Madison, Wis., in the 1980s.

Vancouver Coastal Health and the police department set up Project Link, which has operational control of the two ACT teams (another is being considered) and is co-chaired by a director of Mental Health and Addictions and Insp. Ralph Pauw.

“Our goals are to improve the lives of this marginalized, vulnerable cohort who are seriously addicted and mentally ill and do it collaboratively and hopefully outside of the criminal justice system by reducing police contact with them,” Tran said.

The ACT teams have their own lineup of psychiatrists, mental health nurses, social workers, vocational therapists, addiction counsellors, peer support workers, Aboriginal cultural support workers and plainclothes police officers.

“There was some discussion about this but I felt we don’t need to be in uniform,” Tran said.

“With the ACT team we are proactive. We target clients, almost like we do chronic offenders. It’s mutually beneficial to them, to the public, to the health care system and to the police.

“We believe if we can stabilize them, get them housing and get them on a treatment regime, we can reduce their contact with the police and the health care system, and so far it’s rung true,” Tran said.

A number of the mentally ill in the Downtown Eastside are notorious for their level of contact with police and since the ACT teams became operational, Tran said, beat officers have come into his office asking what had happened to them.

“They’ll say ‘we haven’t seen so-and-so, where is he?’ And I’ll say ‘the ACT team’s looking after him and he’s getting the treatment he should have been getting for all these years.’ ”

Last summer members of the team took some of their clients canoeing in Deep Cove.

“I was a bit hesitant taking a group of people — some of whom are suicidal — canoeing. And I’m thinking, ‘I’m going to have to rescue someone here,’ but it was one of the best experiences of my life,” said Tran.

“We see these people ranting and screaming and saying incoherent things in bus shelters and yet in my canoe was one of the most intelligent and articulate men I’ve ever met. But I’d never seen that in him before.

“It struck me then that they are not just clients that we have to treat and try to keep out of court, but they have families, they have a history, they have a previous life — some very tragic.

“It was amazing to share that moment, that very human moment, with them.”

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Vancouver police mental health team tries to stop the revolving door of arrest and treatment

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